NUR 256
EXAM 4 STUDY GUIDE
Concepts of Mental Health Nursing
Galen College of Nursing
, Review for Exam 4
Chapter 18 Feeding, Eating & Elimination Disorders
Eating Disorders
o Anorexia nervosa
Doesn’t eat, has a need for control and feels powerlessness
Found in household that are more chaotic and relationships are strained.
Always see themselves as overweight.
Push it around the plate & over exercise.
Laxatives or regurgitation.
Fear of gaining weight
Distorted body image
Restricted calories and low BMI
Comorbidities
Bipolar
Depressive
Anxiety
OCD
o Bulimia nervosa
Eats a whole lot at one time and then purges via self-induced vomiting, often hasn’t achieved a status in life
that person had hoped to achieve, feels powerlessness.
As coping
More normal weight in appearance.
Recurrent episodes of uncontrollable binging
Inappropriate compensatory behaviors, vomiting, laxatives, diuretics, or exercise
Self image largely influenced by body image
Etiology
o Biological factors
Genetics – strong genetic link 60% inheritiable
Neurobiological – altered use of serotonin, perfectionists traits & OCD
o Psychological factors – currently, some say it is a learned behavior that has (+) reinforcement
Symptoms as a defense against a feeling of ineffectiveness and powerlessness
o Environmental factors – culture and how we see beautiful women as tall and thin
o This represents the diathesis stress model where the disorder can be caused from genetic disposition and/or
environmental stressors
Anorexia Nervosa Nursing Process
o Assessment
Box 18.2 Thoughts & Behaviors Associated with Anorexia
Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
Peculiar handling of food, cutting food into small bits
Pushing pieces of food around plate
Possible development of rigorous exercise regimen
Possible self induced vomiting, use of laxatives and diuretics
Cognition so disturbed that individual judges self worth by their weight
weight loss of 30% or more in 6 months, rapid decline in weight.
Hypothermia, decreased HR, low systolic criteria for admission.
Electrolytes and arrhythmias and become suicidal or hurting themselves.
Must gain 2 lbs a week and then things may have things taken from them.
o Nursing diagnosis
o Outcomes identification
o Planning
, Immediate medical stabilization if experiencing extremem fluid electrolyte imbalance
Weighs below 75% of ideal body weight
Less than 10% fat
HR less than 50 bpm
Systolic less than 90
Temp less than 96 and arrhythmias
o Implementation
o Evaluation – is it effective?
Assessment: Clinical Picture
o Under-nourished
o Under-weight
o Sunken eyes
o Sagging skin
o Poor skin turgor
o Amenorrhea
o Bradycardia
o Electrolyte Imbalance
o Disturbed Body Image
o Dehydration
Addressing physiological needs FIRST
o Patient may need TPN & fluids
May be resistant
DO NOT DISCUSS WHAT THEIR WEIGHT IS
Nursing Diagnosis
o Alterations in nutrition; less than body requirements
o Less Than Body Requirements r/t decrease intake
o Body Image Disturbance – takes longer
o Alterations in (or potential for) skin integrity r/t cellular starvation
o Ineffective Coping
Outcome
o The client will gain a minimum of 2 pounds per week.
o Therefore, privileges and restrictions are based on compliance with treatment as evidenced by weight gain
Anorexia Nervosa Interventions
o Acute care
Medical Intervention- What has to be treated?
Psychosocial interventions- What are the considerations?
Pharmacological interventions- What might be ordered for this client?
Integrative medicine- What does integrative mean?
Health teaching and health promotion- Topics to discuss?
Safety and teamwork- NPSG stick to menu
o Psychological needs need to be met first
o Psychosocial – investigate home life,
o No meds SSRI helpful with OCD part
o Yoga, acupuncture
o Understanding what is happening to their body that they are doing
o Monitor their bathroom
Nursing Interventions
o Weigh each morning after 1st void with the same amount of clothing on each morning
o Small, frequent feedings (shift in electrolytes)
Refeeding syndrome
o Provide protein shakes (muscle)
o Monitor intake
o Accompany to bathroom for at least up to 1 hour after meals
o Adm. meds as ordered
o Weigh daily/weekly/as ordered
o Participant in the milieu
o Participant in group
o Individual, family, and group therapy
o Health and nutrition teaching
EXAM 4 STUDY GUIDE
Concepts of Mental Health Nursing
Galen College of Nursing
, Review for Exam 4
Chapter 18 Feeding, Eating & Elimination Disorders
Eating Disorders
o Anorexia nervosa
Doesn’t eat, has a need for control and feels powerlessness
Found in household that are more chaotic and relationships are strained.
Always see themselves as overweight.
Push it around the plate & over exercise.
Laxatives or regurgitation.
Fear of gaining weight
Distorted body image
Restricted calories and low BMI
Comorbidities
Bipolar
Depressive
Anxiety
OCD
o Bulimia nervosa
Eats a whole lot at one time and then purges via self-induced vomiting, often hasn’t achieved a status in life
that person had hoped to achieve, feels powerlessness.
As coping
More normal weight in appearance.
Recurrent episodes of uncontrollable binging
Inappropriate compensatory behaviors, vomiting, laxatives, diuretics, or exercise
Self image largely influenced by body image
Etiology
o Biological factors
Genetics – strong genetic link 60% inheritiable
Neurobiological – altered use of serotonin, perfectionists traits & OCD
o Psychological factors – currently, some say it is a learned behavior that has (+) reinforcement
Symptoms as a defense against a feeling of ineffectiveness and powerlessness
o Environmental factors – culture and how we see beautiful women as tall and thin
o This represents the diathesis stress model where the disorder can be caused from genetic disposition and/or
environmental stressors
Anorexia Nervosa Nursing Process
o Assessment
Box 18.2 Thoughts & Behaviors Associated with Anorexia
Terror of gaining weight
Preoccupation with thoughts of food
View of self as fat even when emaciated
Peculiar handling of food, cutting food into small bits
Pushing pieces of food around plate
Possible development of rigorous exercise regimen
Possible self induced vomiting, use of laxatives and diuretics
Cognition so disturbed that individual judges self worth by their weight
weight loss of 30% or more in 6 months, rapid decline in weight.
Hypothermia, decreased HR, low systolic criteria for admission.
Electrolytes and arrhythmias and become suicidal or hurting themselves.
Must gain 2 lbs a week and then things may have things taken from them.
o Nursing diagnosis
o Outcomes identification
o Planning
, Immediate medical stabilization if experiencing extremem fluid electrolyte imbalance
Weighs below 75% of ideal body weight
Less than 10% fat
HR less than 50 bpm
Systolic less than 90
Temp less than 96 and arrhythmias
o Implementation
o Evaluation – is it effective?
Assessment: Clinical Picture
o Under-nourished
o Under-weight
o Sunken eyes
o Sagging skin
o Poor skin turgor
o Amenorrhea
o Bradycardia
o Electrolyte Imbalance
o Disturbed Body Image
o Dehydration
Addressing physiological needs FIRST
o Patient may need TPN & fluids
May be resistant
DO NOT DISCUSS WHAT THEIR WEIGHT IS
Nursing Diagnosis
o Alterations in nutrition; less than body requirements
o Less Than Body Requirements r/t decrease intake
o Body Image Disturbance – takes longer
o Alterations in (or potential for) skin integrity r/t cellular starvation
o Ineffective Coping
Outcome
o The client will gain a minimum of 2 pounds per week.
o Therefore, privileges and restrictions are based on compliance with treatment as evidenced by weight gain
Anorexia Nervosa Interventions
o Acute care
Medical Intervention- What has to be treated?
Psychosocial interventions- What are the considerations?
Pharmacological interventions- What might be ordered for this client?
Integrative medicine- What does integrative mean?
Health teaching and health promotion- Topics to discuss?
Safety and teamwork- NPSG stick to menu
o Psychological needs need to be met first
o Psychosocial – investigate home life,
o No meds SSRI helpful with OCD part
o Yoga, acupuncture
o Understanding what is happening to their body that they are doing
o Monitor their bathroom
Nursing Interventions
o Weigh each morning after 1st void with the same amount of clothing on each morning
o Small, frequent feedings (shift in electrolytes)
Refeeding syndrome
o Provide protein shakes (muscle)
o Monitor intake
o Accompany to bathroom for at least up to 1 hour after meals
o Adm. meds as ordered
o Weigh daily/weekly/as ordered
o Participant in the milieu
o Participant in group
o Individual, family, and group therapy
o Health and nutrition teaching
